Breast milk is the most ideal natural food for babies, but for lactating women with hypertension, there is often a contradiction, that is, high blood pressure is not controlled, which will affect the health of the mother, and lactation antihypertensive drug treatment, but also take into account the safety of the mother and the baby, fully consider the risk and benefit of medication.
Due to the lack of clinical trial data, in order to avoid risks, drug manufacturers do not advocate for use in lactating women in the instructions of commonly used antihypertensive drugs. Seeing these drug instructions, nursing mothers will be confused, and they often ask questions such as: Can antihypertensive drugs be used during lactation? Are antihypertensive drugs harmful to babies? Do I want to stop breastfeeding? Let's talk specifically about these drugs.
First, the safety classification of lactation medication
American scholars divide lactation drugs into 5 levels: L1, the safest, large-sample controlled study, after taking the drug by nursing mothers, no side effects on infants were found; L2, safer, small-sample controlled studies, no side effects on infants were found after lactating mothers took the drug; L3, moderately safe, no controlled studies were conducted during lactation, but there were very minor non-fatal side effects in feeding infants, which may be harmful; L4, which may be dangerous, harmful to feeding infants; L5, contraindicated, contraindicated, contraindicated in lactating women. Lactating women should try to choose L1, L2 drugs.
In addition, the smaller the baby, the greater the effect of the drug in the breast on the baby. According to the size and physical condition of the infant's age, it can be divided into: low-risk, infant size in 6 to 18 months, medium-risk, infant size in 2 weeks to 6 months, high-risk, infant is newborn, premature birth or renal insufficiency.
Second, the amount of antihypertensive drugs secreted in breast milk
We are looking forward to a blood pressure medication, which is preferably only in the serum of lactating women and not through milk secretion, but so far no such antihypertensive drugs have been found that are not secreted through breast milk, but the amount of secretion is different.
RID is now commonly used to assess the dose of the drug consumed by breast milk in infants. RID is the ratio of the drug consumed per unit weight of the infant to the concentration of the drug per unit body weight of the mother. In general, the smaller the RID, the smaller the impact on the baby. RID < 10% and is generally considered to have less impact on infants and can be safely used in lactating women.
Third, antihypertensive drugs that can be used during lactation
1. Methyldopa Its lactation grade is L2, RID is 0.1% to 0.4%, which has little effect on infants and can be used.
2. Betaproctor blockers which can be used with propelolol (lactation grade L2, RID 0.3%), labetalol (lactation grade L2, RID 0.6%) and metoprolol (lactation grade L3, RID 1.0%) can be used. Atenolol, because of its low protein binding rate, is excreted through the kidneys, which is potentially harmful to infants and should be avoided during lactation. Carvedilolol and bisoprolol do not have sufficient evidence to be safe for use in lactating women, so they should be avoided. Beta-blockers require monitoring of the baby's heart rate, blood pressure, and growth and development.
3. Calcium ion antagonist nifedipine (lactation grade is L2, RID is 2.3%), vera patmi (lactation grade is L2, RID is 0.15%), diltiazem (lactation grade is L3, RID is 0.9%) can be used.
4. Angiotensin-converting enzyme inhibitor Captopril (lactation grade is L2, RID is 0.0002%), enalapril (lactation grade is L2, RID is 0.175%), can be used during lactation. This is completely different from gestational hypertension, and patients with hypertension in pregnancy should absolutely contraindicate this type of drug.
Other antihypertensive drugs avoided during lactation are angiotensin receptor antagonists, which currently do not have sufficient evidence to be used during lactation. Diuretics, which affect the amount of breast milk, are generally not recommended.
In addition, the lactation time should try to avoid the peak period of the concentration of the drug in the blood, and the peak time of the blood concentration of different drugs is different, which is generally stated in the drug instructions.
For women with high blood pressure, most antihypertensive medications can be safely used during lactation if the baby is in good physical condition. However, the baby's month and health status should be taken into account when choosing the drug, and the baby's blood pressure, heart rate and development need to be monitored during the medication. At the same time, pay attention to rest during breastfeeding, maintain a good attitude, and actively exercise.